Mental health "reform' that failed

Published 4:00 am, Wednesday, March 3, 1999

1999-03-03 04:00:00 PDT CALIFORNIA -- Sacramento

THE CALIFORNIA Legislature, which wastes much of its time on trivia and irrelevancies, did a rare bit of serious business the other day.

A joint legislative hearing delved into California's three-decade-old "reform" of mental health laws, specifically a searing evaluation conducted by an independent commission. The picture that emerged from the day-long hearing was not a pretty one.

In the 1960s, there was a rare convergence among civil rights-conscious liberals and tightfisted conservatives. They agreed on phasing out California's extensive system of institutionalized care and substituting a network of presumably well-financed community mental health clinics.

Liberals liked the idea of ending involuntary confinement of the mentally disturbed in state hospitals, which had developed a reputation - deserved or not - for squalor and repression. Conservatives, meanwhile, liked slenderizing state government.

One by one, state hospitals were closed and converted to other uses. Tens of thousands of patients were released, supposedly to return to their communities and families and receive drugs and other forms of treatment in the local clinics. Only a few hospitals remained open to serve those with developmental disabilities or other patients too severely impaired to be released.

But, as the independent study panel told the Legislature, the shift to community-based mental health clinics has been a disaster.

The clinics were never underwritten financially to the promised level, and cash-strapped counties often slashed mental health services after Proposition 13 curtailed their revenues.

Countless thousands of mentally ill Californians in earlier days would have been hospitalized. They now wander the streets, homeless and often running afoul of police when their illnesses - especially schizophrenia and manic-depression - cause violent outbursts.

Police and prisons, which should be dealing with sane if misguided criminals, often find themselves, in the words of Assemblywoman Helen Thomson, D-Davis, "the provider of last resort" to the mentally ill.

The study panel estimated that while the state hospital population has shrunk from 35,000 in the 1960s to about 4,000 today, there are at least 20,000 mentally ill inmates in jails and prisons - and a like number of homeless people who are mentally ill.

The study and the hearings underscored two problems, one obvious and the other subtle.

It's obvious that 30 years after the fact, the change in mental health policy was a big mistake. As Dr. L. Fuller Torrey of the Stanley Foundation told legislators, a system of voluntary clinics, even if well financed and staffed, cannot effectively deal with severely ill persons because, by the nature of their illnesses, "most of the people don't think they're sick" and therefore will shun treatment.

He and many other experts are calling for a partial return to the old involuntary system, making clinic visits mandatory as a condition of release from hospitals.

But it's not a universally held belief, as many of the mentally ill themselves and their advocates insist that treatment remain voluntary.

Thus the Legislature - if it's willing to take the political heat - must step in.

The only certainty is that the status quo is an ever-worsening disaster.

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The second problem is purely political. And that is the folly of making some sweeping policy change based on an assumption that future governors and legislators will follow through on commitments.

The mental health debacle should make us all leery about government's endemic inability to deal with long-term issues.&lt;

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